§ 10-505. Purpose and findings.

(a)

Since the 1990's, the abuse of prescription opioids has risen dramatically, due in large part to the increase in the use of these analgesics to manage pain. Opioids are prescribed to alleviate pain ranging from moderate to severe, as described by the patient. These analgesics principally affect the nervous system, suppressing the signlas of pain sent to the brain; examples of these medications can include, but not be limited to, morphine, codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), and related drugs. As opioids "block the perception of pain" they also have the affect of creating a state of euphoria, which may be heightened when abused. Side effects can include drowsiness, nausea, constipation, and respiratory constraint.

(b)

Opioids are recognized as very effective when taken as prescribed for legitimate pruposes, post surgery, for example. As the National Institute on Drug Abuse states, "Many studies have shown that the properly managed, short-term medical use of opioid analgesic drugs is safe and rarely causes addiction - defined as the compulsive and uncontrollable use of drugs despite adverse consequences - or dependence, which occurs when the body adapts to the presence of a drug, and often results in withdrawal symptoms when that drug is reduced or stopped." Unfortunately, opioids taken long-term can create physical dependency in some patients, producing withdrawal symptoms when the medication is not taken. Cessation side effects can include bone pain, insomnia, and vomiting, to name a few.

(c)

Since the tragic events of September 11, 2001, the rise in the diversion of legal prescription drugs has grown exponentially, due to increased security at the borders and ports. Amplified security has effectively reduced the supply of illegal drugs, traditional smuggled by the drug trade, necessitating the need to find alternative methods of supplying drugs to users; consequently, legal prescription drugs are now being diverted to illegal uses - "diversion." These diverted drugs are Schedule II, III and IV drugs, which principally include opioids as well as complementary drugs.

(d)

In recent years, South Florida, including Miam-Dade, Broward, and Palm Counties, have witnessed tremendous growth in the number of "pain clinics" that have opened in addition to the rapid increase of the diversion of prescription drugs. Broward County has been termed "The Painkiller Capital of the Unites States," and "The Columbia for Pharmaceutically Diverted Drugs." Broward County had four (4) pain clinics in 2007, jumping to one hundred fifteen (115) by November 2009, of a total of one hundred seventy-six (176) such clinics in all of South Florida. The majority of these pain clinics are nothing more than pill mills, diverting these scheduled drugs to illegal uses. As "clinics" have multiplied, the deaths due to overdoses of prescription drug medications, specifically opioids, have skyrocketed.

(e)

With Broward County on the forefront of this epidemic, a grand jury was empanelled to investigate, issuing a report on November 19, 2009, after hearing testimony from prescription drug abusers and their families, federal and state law enforcement officials, physicians, prosecutors, and many more stakeholders. The report provides valuable information regarding the current state of this epidemic as well as recommendations to curtail this rapidly growing public safety concern.

(f)

As Broward County and other South Florida jurisdictions struggle to eliminate "pill mills", this outbreak of illicit pain clinics crossed into other states, notably Georgia and Texas. In fact, the Cobb County Prescription Drug Task Force reports that in 2007, 82.46 percent overdose deaths state-wide involved pharmaceuticals, going to 85.11 percent in 2008. Alprazolam, Hydrocodone, and Oxycodone were found to constitute the top five (5) substances involved in all of these overdose deaths. Alprazolam, commonly known by the trade name Xanax, an anxiety medications, is often combined and distributed with opioids at illegal pain clinics.

(g)

Illegal pain clinics commonly known as "pill mills" dispense large quantities of Schedule II, III and IV drugs for cash, with little examination of the patient conducted. Scheduled drugs are dispensed at these establishments or prescriptions are written to be filled at a legitimate pharmacy. Often, out of jurisdiction and out-of-state license plates are in the parking lots of these clinics, with individuals driving great distances to receive these "prescriptions." Pill mills often hire security guards to handle unruly patients and perhaps even scout for law enforcement. Individuals seeking these services will often fake an ailment, forging an MRI or providing falsified medical documentation to receive prescriptions. In turn, the physicians conduct lackadaisical examinations of these individuals, simply asking them "what they want" with regard to medication.

(h)

The City of Cartersville City Council adopted a twelve-month moratorium on the issuance of occupational tax certificates to "pain management clinics" on April 21, 2011, to conduct the proper research and vetting to create a new ordinance and Municipal Code addressing "pill mills." After thorough research, the city council has prepared these provisions to eliminate this rapidly emerging epidemic, creating a new article in the Code of the City of Cartersville.

(i)

Not all pain clinics are "pill mills," thus the challenge of regulating this epidemic is daunting. Pill mills could easily be found in establishments that provide physical therapy, chiropractics, or general medicine, through the "pain clinic" title is most commonly associated with such operation. Therefore, the city council finds that "pill mills," pose a current and real threat to the health, safety and welfare of the people of the City of Cartersville, and therefore make the following declarations:

(1)

The "pill mill" has become a store front for the new illegal drug trade, as legitimate prescription medication is diverted for illicit purposes.

(2)

"Pill mills" must be regulated and differentiated from legitimate healthcare providers, as they attempt to enter the Georgia market from Florida and other neighboring states which are beginning to adopt regulatory legislation.

(3)

"Pill mills" are often owned, operated and staffed by unlicensed proprietors, with little or no medical training.

(4)

"Pill mills" masquerade as legitimate pain management establishments or medical providers, but instead perform few, if any, medical examinations with often sparsely furnished offices and no typical medical equipment.

(5)

"Pill mills" operate on a cash basis, usually not accepting checks, credit cards, or health insurance, creating an environment that poses a security threat in light of the clientele seeking these illicit services.

(6)

Individuals seeking "pill mill" services often falsify symptoms or provide bogus documentation of an ailment to receive powerful Schedule II, III and IV drugs. Alternative methods of treatment, physical therapy, surgery, etc., are rarely ever proposed to a patient seeking services from a "pill mill".

(7)

Individuals will often "shop" various "pill mills" receiving multiple prescriptions on the same day or during a short period of time, thereafter reselling the pills to generate a profit to fund their own addiction and purchase additional supplies.

(8)

"Dealers" or groups of dealers often sponsor individuals who obtain Schedule II, III and IV drugs repeatedly over multiple "pill mills", during a short period of time. These large quantities may then be resold at a much higher value to fund the purchase of larger quantities as well as to continue the abuse of these powerful drugs by the individuals involved.

(9)

Individuals seeking "pill mill" services will often be consuming these scheduled drugs as they search for the next pill mill. These individuals may be under the influence of one (1) or more of these powerful drugs or suffering from withdrawal symptoms. Pill mills can usually supply scheduled drugs on-site for individuals to consume immediately, as well. Both the influence of the scheduled drug as well as the debilitating withdrawal symptoms affecting a driver operating a motor vehicle in City of Cartersville while seeking a "pill mill" is of grave concern.

(10)

Legitimate pain clinics should be owned, operated and staffed by licensed physicians, boarded in a pain management-related field recognized by the American Board of Medical Specialists.

(Ord. No. 15-12, 2-2-12)